Community Medicine
1 questionsThe number of maternal deaths per 100,000 live births is called-
FMGE 2021 - Community Medicine FMGE Practice Questions and MCQs
Question 1: The number of maternal deaths per 100,000 live births is called-
- A. Maternal mortality rate
- B. Maternal mortality ratio (Correct Answer)
- C. Infant mortality rate
- D. Perinatal mortality rate
Explanation: ***Maternal mortality ratio*** - This is the standard epidemiological indicator defining the number of **maternal deaths per 100,000 live births**. - It measures the risk of death due to pregnancy in a population. *Maternal mortality rate* - This term is often used interchangeably with maternal mortality ratio, but technically, a **rate usually includes time in the denominator** (e.g., deaths per person-year). - While related to maternal mortality, it's not the precise term for deaths per live births. *Infant mortality rate* - This measures the number of **deaths of infants under one year of age per 1,000 live births**. - It does not specifically refer to deaths of mothers. *Perinatal mortality rate* - This calculates the number of **stillbirths and deaths in the first week of life per 1,000 total births** (live births plus stillbirths). - It focuses on deaths around the time of birth in the infant, not the mother.
Internal Medicine
2 questionsA patient presents with severe pain and swelling in his knee joint for 10 days. He also complains of pain and discomfort during urination. He says that he had diarrhea one month ago and he has been unwell since then. What is the most likely diagnosis?
Following complete ileal and partial jejunal resection, the patient is most likely to have-
FMGE 2021 - Internal Medicine FMGE Practice Questions and MCQs
Question 1: A patient presents with severe pain and swelling in his knee joint for 10 days. He also complains of pain and discomfort during urination. He says that he had diarrhea one month ago and he has been unwell since then. What is the most likely diagnosis?
- A. Psoriasis arthritis
- B. Rheumatoid arthritis
- C. Enteropathic arthritis
- D. Reactive arthritis (Correct Answer)
Explanation: Reactive arthritis - This diagnosis is strongly supported by the triad of symptoms: **arthritis** (knee pain/swelling), **urethritis** (pain during urination), and a preceding **gastrointestinal infection** (diarrhea one month prior) [1]. - Reactive arthritis is an inflammatory arthritis triggered by an infection in another part of the body, often **gastrointestinal** or **genitourinary** [2]. *Psoriasis arthritis* - This condition is associated with **psoriasis**, a skin disease characterized by red, scaly patches, which is not mentioned in the patient's history. - While it can affect joints, it does not typically present with a preceding gastrointestinal infection or urethral symptoms. *Rheumatoid arthritis* - **Rheumatoid arthritis** typically presents with symmetric polyarticular joint involvement, often affecting smaller joints like those in the hands and feet, rather than a single large joint like the knee [3]. - It does not typically follow a gastrointestinal infection or involve urethral symptoms. *Enteropathic arthritis* - This type of arthritis is associated with **inflammatory bowel diseases** (IBD) like Crohn's disease or ulcerative colitis. - While diarrhea can be a symptom of IBD, the patient's presentation with acute urethritis points away from enteropathic arthritis as the primary diagnosis, which often involves axial skeleton or peripheral joints but typically not urethral inflammation.
Question 2: Following complete ileal and partial jejunal resection, the patient is most likely to have-
- A. Constipation
- B. Gastric ulcer
- C. Folic acid deficiency
- D. Vitamin B12 Deficiency (Correct Answer)
Explanation: ***Vitamin B12 Deficiency*** - The **terminal ileum** is the primary site for **vitamin B12 absorption**, complexed with intrinsic factor [3]. Resection of this segment significantly impairs this process. - Patients with **ileal resection** are highly susceptible to developing **megaloblastic anemia** and neurological complications due to **vitamin B12 deficiency** [3]. *Constipation* - Complete ileal and partial jejunal resection is **more likely to cause diarrhea** rather than constipation, particularly due to malabsorption of bile salts and fats [2]. - **Bile salt malabsorption** in the colon often leads to secretory diarrhea [1]. *Gastric ulcer* - Gastric ulcers are typically associated with *Helicobacter pylori* infection or NSAID use, and are **not a direct consequence** of ileal and jejunal resection. - While short bowel syndrome can sometimes lead to increased gastric acid secretion, peptic ulcer formation is not the most likely or direct complication. *Folic acid deficiency* - **Folic acid** is primarily absorbed in the **jejunum**, and while partial jejunal resection occurred, complete ileal resection is less directly implicated in folate deficiency. - Other sections of the small intestine can often compensate for partial jejunal loss in folate absorption, making B12 deficiency a more immediate and severe concern after complete ileal resection.
OB/GYN
2 questionsA 27-year-old woman presented with a malodorous discharge in the vagina which started a week earlier. On examination, Whiff's test is positive and the gram stain shows the presence of clue cells. This infection is commonly treated with which of the following?
Which is correct about ABO and Rh incompatibility leading to Erythroblastosis fetalis?
FMGE 2021 - OB/GYN FMGE Practice Questions and MCQs
Question 1: A 27-year-old woman presented with a malodorous discharge in the vagina which started a week earlier. On examination, Whiff's test is positive and the gram stain shows the presence of clue cells. This infection is commonly treated with which of the following?
- A. Metronidazole (Correct Answer)
- B. Azithromycin
- C. Nystatin pessary
- D. Tetracycline
Explanation: ***Metronidazole*** - This patient's symptoms (malodorous vaginal discharge, positive **Whiff test**, and presence of **clue cells** on Gram stain) are classic findings for **bacterial vaginosis (BV)**. - **Metronidazole** is the first-line and most effective antibiotic for treating bacterial vaginosis, as it targets the anaerobic bacteria overgrowing in the vagina. *Azithromycin* - **Azithromycin** is primarily used to treat infections like **chlamydia**, gonorrhea, or some respiratory tract infections. - It is **not effective** against the anaerobic bacteria responsible for bacterial vaginosis. *Nystatin pessary* - **Nystatin** is an **antifungal medication** specifically used to treat **vulvovaginal candidiasis (yeast infection)**. - The patient's presentation (malodorous discharge, positive Whiff test, clue cells) does not align with a yeast infection, making nystatin ineffective. *Tetracycline* - **Tetracycline** is a broad-spectrum antibiotic, but it is **not the preferred treatment** for bacterial vaginosis. - Its use is often associated with a higher risk of side effects and is typically reserved for other bacterial infections like **chlamydia**, acne, or Rocky Mountain spotted fever.
Question 2: Which is correct about ABO and Rh incompatibility leading to Erythroblastosis fetalis?
- A. Cell mediated hypersensitivity
- B. Immune complex
- C. Antigen-antibody reaction
- D. Cytotoxic (Correct Answer)
Explanation: ***Cytotoxic*** - **Erythroblastosis fetalis** involves maternal antibodies (IgG) crossing the placenta and binding to fetal red blood cell antigens, leading to **complement-mediated lysis** of fetal red blood cells. - This is a classic example of a **Type II hypersensitivity reaction**, characterized by antibody-mediated cell destruction. *Cell mediated hypersensitivity* - This refers to **Type IV hypersensitivity reactions**, which involve T lymphocytes and macrophages, not antibodies. - Examples include **contact dermatitis** and **tuberculosis skin tests**. *Immune complex* - This describes **Type III hypersensitivity reactions**, where antigen-antibody complexes form and deposit in tissues, leading to inflammation. - Conditions like **serum sickness** and **lupus nephritis** are examples of immune complex diseases. *Antigen-antibody reaction* - While present, this option is too broad; all hypersensitivity reactions involve some form of antigen-antibody (or antigen-T cell) interaction. - It does not specifically describe the **mechanisms of tissue damage** or the **type of hypersensitivity** involved in erythroblastosis fetalis.
Patient Safety
1 questionsA patient was referred by a doctor to a radiologist for a CT scan and the doctor was given money for the referral. What is this unethical act called?
FMGE 2021 - Patient Safety FMGE Practice Questions and MCQs
Question 1: A patient was referred by a doctor to a radiologist for a CT scan and the doctor was given money for the referral. What is this unethical act called?
- A. Criminal negligence
- B. Commission
- C. Medical maloccurrence
- D. Fee splitting (Correct Answer)
- E. Dichotomy
Explanation: ***Fee splitting*** - **Fee splitting** occurs when a healthcare provider (e.g., a doctor) receives payment for referring a patient to another healthcare provider or service (e.g., a radiologist). - This practice is considered unethical and often illegal because it creates a financial incentive for referrals, potentially leading to unnecessary services or choices not based on the patient's best interest. *Criminal negligence* - **Criminal negligence** involves a reckless disregard for the safety of others, leading to harm, often in situations where a duty of care was owed. - It is characterized by actions or inactions that demonstrate a gross deviation from the standard of care, resulting in injury or death, which is not the case in this scenario. *Commission* - In a medical context, **commission** generally refers to an action taken by a healthcare provider. While the act of referring a patient is a commission, it does not specifically define the unethical monetary exchange. - The term "commission" alone does not convey the unethical nature of receiving money for a referral. *Dichotomy* - **Dichotomy** in medical ethics refers to the division of fees between two healthcare providers for services actually rendered (e.g., a surgeon and assistant surgeon splitting a surgical fee). - While also ethically questionable in many contexts, dichotomy involves splitting fees for work performed, whereas fee splitting involves payment specifically for making a referral without providing additional services. *Medical maloccurrence* - **Medical maloccurrence** is a broad term that refers to an untoward event or bad outcome that occurs during medical care but does not necessarily imply negligence or wrongdoing. - It describes an adverse event that may happen despite appropriate care, which is distinct from an unethical financial arrangement.
Pediatrics
1 questionsVitamin K supplementation is given to neonates to prevent _____ .
FMGE 2021 - Pediatrics FMGE Practice Questions and MCQs
Question 1: Vitamin K supplementation is given to neonates to prevent _____ .
- A. Hemorrhagic disease of the newborn (Correct Answer)
- B. Scurvy
- C. Keratomalacia
- D. Breast milk jaundice
- E. Rickets
Explanation: ***Hemorrhagic disease of the newborn*** - Neonates have low levels of **vitamin K-dependent clotting factors** (II, VII, IX, X) due to poor placental transfer, sterile gut, and low vitamin K in breast milk. - Vitamin K supplementation at birth prevents potentially life-threatening bleeding episodes, known as **hemorrhagic disease of the newborn (VKDB)**, by ensuring adequate clotting factor production. *Scurvy* - Scurvy is caused by **vitamin C deficiency**, leading to impaired collagen synthesis. - Symptoms include **gingival bleeding**, skin hemorrhages, and poor wound healing, which are distinct from vitamin K deficiency. *Keratomalacia* - Keratomalacia is a severe eye condition resulting from **vitamin A deficiency**, characterized by drying and clouding of the cornea. - It leads to **blindness** and is not related to vitamin K metabolism. *Breast milk jaundice* - Breast milk jaundice is a common and usually benign condition in neonates where **breast milk components** interfere with bilirubin metabolism, prolonging physiological jaundice. - It is not prevented by vitamin K and is entirely distinct from coagulation disorders. *Rickets* - Rickets is caused by **vitamin D deficiency**, resulting in defective bone mineralization and skeletal deformities. - Clinical features include **bowed legs**, rachitic rosary, and delayed fontanelle closure, which are unrelated to coagulation or vitamin K.
Pharmacology
1 questionsA patient from a North-Eastern state was diagnosed to have an infection with P. Falciparum malaria. What is the most appropriate treatment for this patient?
FMGE 2021 - Pharmacology FMGE Practice Questions and MCQs
Question 1: A patient from a North-Eastern state was diagnosed to have an infection with P. Falciparum malaria. What is the most appropriate treatment for this patient?
- A. Chloroquine
- B. Mefloquine
- C. Sulfadoxine plus pyrimethamine
- D. Artemether plus lumefantrine (Correct Answer)
- E. Quinine plus doxycycline
Explanation: ***Artemether plus lumefantrine*** - Artemether-lumefantrine is the recommended first-line treatment for **uncomplicated P. falciparum malaria** in regions with known **chloroquine resistance**, such as North-Eastern India. - This combination therapy, an **Artemisinin-based Combination Therapy (ACT)**, is highly effective due to its rapid parasiticidal action and synergy. *Chloroquine* - Chloroquine resistance in **P. falciparum malaria** is widespread, particularly in many parts of India, including the North East. - Using chloroquine alone would likely lead to **treatment failure** and worsening of the patient's condition. *Mefloquine* - Mefloquine is an alternative treatment option, but it has significant drawbacks including **neuropsychiatric side effects** (e.g., anxiety, depression, hallucinations) and a long half-life. - It is often reserved for specific situations or as a second-line agent when ACTs are not available or contraindicated. *Sulfadoxine plus pyrimethamine* - **Sulfadoxine-pyrimethamine (SP)** is an older antimalarial drug combination that is not recommended as first-line treatment for **uncomplicated P. falciparum malaria** due to widespread **parasite resistance**. - While it was formerly used for prophylaxis and intermittent presumptive treatment, its efficacy against P. falciparum has significantly declined. *Quinine plus doxycycline* - **Quinine plus doxycycline** is an effective alternative for treating **P. falciparum malaria**, particularly in **severe cases** or when ACTs are contraindicated or unavailable. - However, it is **not the first-line treatment** for uncomplicated malaria due to longer treatment duration (7 days), more frequent dosing, and potential side effects (cinchonism, GI disturbances). - Requires adherence to a multi-day regimen, making ACTs more practical for uncomplicated cases.
Psychiatry
1 questionsAfter 72 hours of Cessation of alcohol, which of the following withdrawal symptoms can be seen in alcoholic patients?
FMGE 2021 - Psychiatry FMGE Practice Questions and MCQs
Question 1: After 72 hours of Cessation of alcohol, which of the following withdrawal symptoms can be seen in alcoholic patients?
- A. Seizures
- B. Hallucinations
- C. Tremors
- D. Delirium tremens (Correct Answer)
Explanation: **Delirium tremens** - **Delirium tremens** typically manifests **48-96 hours** (2-4 days) after the last drink, making it a key symptom seen around the 72-hour mark. - It involves **severe confusion**, disorientation, **hallucinations** (visual, auditory, tactile), agitation, and autonomic instability like **tachycardia**, hyperthermia, and hypertension, representing the most severe form of alcohol withdrawal. *Seizures* - **Alcohol withdrawal seizures** usually occur much earlier, within **6 to 48 hours** after cessation. - While possible within the broader withdrawal timeline, they are more characteristic of the initial stages rather than the 72-hour peak of delirium tremens. *Hallucinations* - **Alcoholic hallucinosis** typically develops **12-24 hours** after cessation and can persist for days. - While hallucinations are a component of delirium tremens, isolated hallucinosis usually presents earlier without the global cognitive impairment and autonomic instability of DTs. *Tremors* - **Tremors** are among the first signs of alcohol withdrawal, appearing as early as **6-12 hours** after the last drink. - These early symptoms are usually self-limiting or managed with benzodiazepines and precede the more severe stages seen at 72 hours.
Surgery
1 questionsWhich of the following statements is incorrect regarding vasectomy?
FMGE 2021 - Surgery FMGE Practice Questions and MCQs
Question 1: Which of the following statements is incorrect regarding vasectomy?
- A. The procedure is done under local anesthesia
- B. The vas deferens is the structure that is divided in the procedure
- C. A no-scalpel technique is being widely used now
- D. Sterility is achieved 3 weeks after the procedure (Correct Answer)
Explanation: ***Sterility is achieved 3 weeks after the procedure*** - Full sterility after vasectomy is not achieved instantly; it typically takes **at least 8-16 weeks** or approximately **20 ejaculations** to clear residual sperm. - Patients are advised to use other birth control methods until a **sperm count of zero** is confirmed by a semen analysis. *The procedure is done under local anesthesia* - Vasectomy is commonly performed using **local anesthesia**, often alongside mild sedation, making it an outpatient procedure. - This approach minimizes patient discomfort and avoids the risks associated with general anesthesia. *The vas deferens is the structure that is divided in the procedure* - The **vas deferens** is indeed the specific anatomical structure that is cut, tied, or sealed during a vasectomy. - This interruption prevents sperm from traveling from the epididymis to the urethra, thus preventing fertilization. *A no-scalpel technique is being widely used now* - The **no-scalpel vasectomy (NSV)** technique is a modern, less invasive approach that uses a puncturing instrument instead of a scalpel incision. - This method typically results in less pain, bleeding, and a quicker recovery compared to traditional incisional techniques.